Outcomes analysis of a summer asthma camp.

Forty children with moderate to severe asthma were enrolled in an asthma camp. Changes in peak flow meter (PFM) and metered-dose inhaler (MDI) technique, health care utilization, and school absenteeism were evaluated. The mean post-PFM score at the end of camp (8.9 +/- 0.3) was significantly higher (p < .0001) than the pre PFM score (6.0 +/- 3.4). The mean post-MDI score (6.5 +/- 1.5) was significantly higher (p < 0.0001) than the pre-MDI score (4.1 +/- 1.8). Emergency room visits decreased by 59%, hospitalizations decreased by 83%, and school absenteeism decreased from 266 to 188 days. Health care savings totaled $2014 per child enrolled.

Nutrition and immunization survey of Bosnian women and children during 1993.

BACKGROUND: As a result of the war in Bosnia, millions of displaced people and refugees have come to depend upon international donations of food aid. METHODS: We conducted a survey of 120 randomly selected 'clusters' of households in the Bosnian regions of Sarajevo, Tuzla, Zenica and Bihac (30 'clusters' in each region). Children from 6 to 59 months and their mothers were selected and their nutritional status was examined. Children aged 13-25 months and infants under 16 weeks were also assessed for their immunization status and infant feeding practices respectively. RESULTS: There were no clinical signs of protein-energy undernutrition or micronutrient deficiency in children. Similarly, there were no clinical signs of undernutrition in adults, although 10.8% of the resident women in Sarajevo and 11.9% in Zenica had a Body Mass Index (BMI) below 18.5. Total BCG coverage was 94% while the coverage for DPT/polio was only 55% in Sarajevo and 49% in Zenica. Only 5% of mothers were exclusively breastfeeding babies under 16 weeks. CONCLUSION: While the coverage of the survey was not nationwide and was limited to the first year of the war, the results indicate that in this period serious hunger and undernutrition were prevented in Bosnia, though they suggest that appreciable loss of weight is likely to have occurred. Immunization coverage, except for BCG, and exclusive breastfeeding levels were poor.

PIP: The war in Bosnia has displaced millions of people. These individuals and refugees now depend upon international food aid. The authors surveyed 120 randomly selected clusters of households in the Bosnian regions of Sarajevo, Tuzla, Zenica, and Bihac to assess nutritional status, immunization status, and infant feeding practices. Children aged 6-59 months and their mothers were selected and their nutritional status examined. Children aged 13-25 months and infants younger than 16 weeks were also assessed for their immunization status and infant feeding practices, respectively. Research found no clinical signs of protein-energy undernutrition or micronutrient deficiency in children. Furthermore, there were no clinical signs of undernutrition in adults, although 10.8% of the resident women in Sarajevo and 11.9% in Zenica had a body mass index (BMI) under 18.5. Total BCG coverage was 94%, while the coverage for DPT/polio was 55% in Sarajevo and 49% in Zenica. Only 5% of mothers were exclusively breastfeeding babies younger than 16 weeks.

Nutrition and infant feeding survey of women and children in Sarajevo during July 1993.

OBJECTIVE: To collect baseline information on nutritional status and infant feeding practices in besieged Sarajevo and to identify areas for action. DESIGN: Thirty communities (clusters) were randomly selected from 84 local communities within besieged Sarajevo. A starting point within a community was randomly selected and subsequent houses visited until the required sample size was reached. 19 collective centres were included in a separate sample. SETTING: The survey was carried out in besieged Sarajevo during July 1993. SUBJECTS: Subjects included residents and refugees. The nutritional status of 524 children aged from six to 59 months and 494 women of child-bearing age was assessed. Information on feeding practices was obtained from a subsample of 64 mothers with babies less than 16 weeks old. MEASUREMENTS: Children and the women who accompanied them were weighed and measured. Weight for height Z scores were calculated for children and body mass index (BMI) was calculated for women. A structured questionnaire on infant feeding practices was administered to mothers of babies. RESULTS: There were no indications of undernutrition in children above the 2.5% which would normally be expected in a population. Among resident women, 10.8% had a BMI < 18.5, compared to 4.4% among refugee women in private accommodation and 8.6% in collective centres. The weights of refugee women in collective centres were significantly higher than the weights of resident women (ANOVA, p = 0.03). Only 6% of mothers with babies less than 16 weeks old were exclusively breast feeding. CONCLUSION: Nutritional monitoring proved to be possible and useful in assessing breast feeding practices and nutritional status. The level of exclusive breast feeding was extremely low, probably due to lack of relevant education of health workers.

Nutritional effects of the siege on new-born babies in Sarajevo.

OBJECTIVE: To investigate the influence of maternal nutrition on perinatal mortality, morbidity, malformations and low birth weight (< 2500 grams). DESIGN: All mothers and their babies born in Kosevo Hospital during three different time periods were sampled: September 1992 to February 1993 (pilot study), May 1993 to February 1994 (main study) and statistics compiled in 1991 (pre-war). SETTING: Data were collected at the gynaecology and obstetric clinic, Kosevo hospital, city of Sarajevo. SUBJECTS: A total of 920 babies were included in the pilot study, 1225 mothers of 1237 babies participated in the main study and birth data from 8676 babies born in 1991 were used as baseline data. INTERVENTIONS: Birth outcome data were compiled for all three time periods. In the main study, a questionnaire was administered on arrival at the clinic in which mothers were asked to estimate their weight prior to pregnancy. Information on energy and protein intake was collected for all women by estimating weekly food intake during pregnancy. Mothers were weighed and had their heights measured within 12 hours of delivery. Women were divided into three groups based on their body mass index (BMI) using self-reported prepregnancy weight (underweight BMI < 21.5; normal weight BMI 21.5-25.6; overweight BMI > 25.6). Four groups were defined according to dietary intake during pregnancy (daily energy intake < 2755 kcal and 2755 + kcal; protein intake < 80 and 80 + grams). RESULTS: Weight gain during pregnancy was low in overweight women (3.2 kg) compared with normal weight (10.4 kg) and underweight (11.7 kg) women. Underweight women had babies with the lowest mean birthweight (3072 grams) and the highest percentage of low birth weight babies (13.0%). Perinatal mortality increased from 15.8/1000 live births in 1991 (pre-war) to 36/1000 in May 1993-February 1994. Morbidity among babies increased from 3.4% to 8.2% in the same time period. There was a significant increase in babies born with malformations from 0.4% in the pre-war period to 3.0% in May 1993 to February 1994. CONCLUSIONS: It is concluded that the war has had a deleterious effect on birth outcomes in Sarajevo.